Provider Demographics
NPI:1427143015
Name:WIATRAK, BRIAN JEFFERY (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JEFFERY
Last Name:WIATRAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BRIAN
Other - Middle Name:JEFFERY
Other - Last Name:WIATRAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4931 COLD HARBOR DRIVE
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM,
Mailing Address - State:AL
Mailing Address - Zip Code:35223
Mailing Address - Country:US
Mailing Address - Phone:205-951-5488
Mailing Address - Fax:
Practice Address - Street 1:1940 ELMER J. BISSELL ROAD
Practice Address - Street 2:PEDIATRIC ENT ASSOCIATES
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243
Practice Address - Country:US
Practice Address - Phone:205-638-4949
Practice Address - Fax:205-638-4983
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17153207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL2322124OtherCIGNA HEALTH CARE
AL1205935012OtherHOSPITAL NPI
AL000045535Medicaid
AL63030730626OtherCHILDRENS HOSPITAL
AL63030730629OtherCHILDRENS SOUTH
AL1010005OtherUNITED HEALTHCARE
AL25457OtherSOUTHERN HEALTH SYSTEMS
AL529903800Medicaid
AL1205935012OtherHOSPITAL NPI
AL2322124OtherCIGNA HEALTH CARE
AL25457OtherSOUTHERN HEALTH SYSTEMS
AL1010005OtherUNITED HEALTHCARE
AL63030730626OtherCHILDRENS HOSPITAL